One Doctor's 5 Rules to Battle More Testing and Treatment

Asking for “more” has caused trouble over the ages. Adam
and Eve wanted more food choices, the people of Pompeii wanted more
mountain-side housing, Napoleon and Adolph Hitler wanted to spend more
time in Russia, and America wanted more of the Kardashians. We can all
see what destruction those desires reaped.

Americans have been viewing health care the same way, always wanting
more: more antibiotics, more technology, more robots doing more surgery,
more expensive treatments for more diseases. The result: health care
costs more in America than anywhere else. Some folks think that our
“more” approach makes our health care “the best in the world,” after
all, where else can you get so many tests just by asking. MRI’s for
back pain, x-rays for coughs, blood tests for anyone who dons the door
of the ER. ”Tests for everyone!” shouts the bartender. “Tests are on
the house! ”

They aren’t, of course, and we are paying the price for “more.” This
hunger for “more” is fueled by the media’s fascination for the “latest
thing,” the long disproved idea that technology will solve everything,
and docs who aren’t willing to take time to explain why it’s actually
better to do less. It’s hard to do, when we are paid more to spend less
time with patients, and when the system is willing to pay for more and
more.

…

Ultimately, I want my patients to see as few doctors, be sick as
infrequently, and be on as few drugs as possible. I hope to wage an
all-out assault on “more.”

Here are my rules to battle “more”

Never order a test that doesn’t help you decide something important. Ordering tests “just to know” does much more harm than good.

Use consultants only to do things you can’t.
Orthopedists will always give an NSAID [non-steroidal anti-inflammatory drug] and physical therapy for problems,
so I don’t send patients to them unless they’ve failed those treatments
(where appropriate). I am just as good at ordering PT, and am more
careful with NSAID prescriptions than they are.

Don’t give a patient a drug without explaining to them why they need it.
If I can’t make a good case for a drug, I shouldn’t be giving it. This
is not simply “to lower your cholesterol,” or “to treat your blood
pressure,” but because doing so will raise your life expectancy.

Remember the number that really matters: how many birthdays a person gets to celebrate in health. I don’t care about blood pressure, LDL, or even A1c if treating it doesn’t raise the birthday total.

Don’t forget about another number: how much money patients have in their wallets.
There’s no point in ordering a drug they can’t afford, or making them
pay for a test they don’t need (even when they ask for either).

Last year, Lamberts announced he was making a “change from a
traditional to a direct-care practice… I am only taking a maximum of
1000 patients (less at the start) and will be no longer accepting
insurance. These changes make it impossible for me to continue in a
doctor-patient relationship with most of my patients.”

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